Cervical spine motion during flexible bronchoscopy compared with the Lo-Pro GlideScope

Area of Science:

• Anesthesiology
• Emergency Medicine
• Neurosurgery

Background:

• Cervical spine (CS) immobilization during tracheal intubation is critical in patients with suspected injury.
• The optimal device for intubation in these patients remains debated.
• Videolaryngoscopes are increasingly used, but their effect on CS movement needs evaluation.

Purpose of the Study:

• To compare cervical spine movement during tracheal intubation using the Lo-Pro GlideScope (LP-G) videolaryngoscope versus flexible bronchoscopy (FB).
• To assess the impact of airway maneuvers on CS movement during FB intubation.

Main Methods:

• Randomized trial of 28 healthy adults undergoing intubation.
• Continuous fluoroscopy to measure CS angulation changes (Occ-C1 to C4-5).
• Comparison of LP-G vs. FB, and assessment of tongue pull and jaw thrust maneuvers before FB.

Main Results:

• LP-G caused significantly greater cervical extension than FB at Occ-C1, Occ-C2, and Occ-C4.
• Tongue pull maneuvers with FB resulted in less CS motion than FB alone.
• Jaw thrust with tongue pull showed a trend towards increased CS movement compared to FB alone.

Conclusions:

• In non-immobilized adults, LP-G causes more cervical spine movement than FB during intubation.
• Airway maneuvers, particularly jaw thrust, can increase CS movement during FB intubation.
• Careful consideration of device and technique is necessary to minimize CS movement in at-risk patients.